Healthcare Provider Details

I. General information

NPI: 1447689427
Provider Name (Legal Business Name): NEW JERSEY STAR ACO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 ROUTE 10 SUITE 303
PARSIPPANY NJ
07054-4507
US

IV. Provider business mailing address

1719 ROUTE 10 SUITE 303
PARSIPPANY NJ
07054-4507
US

V. Phone/Fax

Practice location:
  • Phone: 973-292-9496
  • Fax: 973-292-1050
Mailing address:
  • Phone: 973-292-9496
  • Fax: 973-292-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JANE LISS
Title or Position: CEO
Credential: MPA
Phone: 973-292-9496